Teens’ Use of Indoor TanningTeens’ Use of Indoor Tanning

Joni A. Mayer, PhD, Professor

Graduate School of Public Health

San Diego State University

Presented at the meeting of the National Council on Skin Cancer Prevention, November 7, 2008, Washington, D.C.

Why study indoor tanning among Why study indoor tanning among teens?teens?

• Using indoor tanning early in life increases melanoma risk by 75%

• U.S. older teen girls are using indoor tanning at high rates—up to 40%

World Health OrganizationWorld Health Organization

• Ban those under 18 years old from commercial indoor tanning….

Sinclair, C. Artificial tanning sunbeds: risks and guidance. WHO, 2003.

Correlates of Indoor Tanning in Youth

Availability of Facilities

Environmental LevelEnvironmental Level

ADOLESCENT USE OFINDOOR TANNING

ParentCharacteristics

AdolescentCharacteristics

Individual andIndividual and Sociocultural LevelSociocultural Level

Policy LevelPolicy Level

StateLegislation

LocalEnforcementProcedures

FacilityCompliance

PhoneInterviews(N=6,125)

Facility Count+ Locations/GIS

QuantificationOf

Stringency

Confederate Phone Calls

(N=3,399)

QuantificationOf

Stringency

Results from generalized linear Results from generalized linear mixed effects modelsmixed effects models

Mayer, J. A., Slymen, D. J., Woodruff, S. I., Hoerster, K. D., Pichon, L. C., Sallis, J. F., Weeks, J. R., & Belch, G. E. (2008, October).  Correlates of indoor tanning among teens: Key findings from CITY100. Peer-reviewed paper presented at the annual meeting of the American Public Health Association, San Diego, CA.

Individual-level predictors

Variable OR CI

sex:female=1.0 .42 .26, .68

Individual-level predictors

Variable OR CI

sex:female=1.0 .42 .26, .68

age 17: 14=1.0 1.8 1.2, 2.6

Indoor tanning among CITY100 teens

0

5

10

15

20

25

30

14 15 16 17

Males

Females

Individual-level predictors

Variable OR CI

sex:female=1.0 .42 .26, .68

age 17: 14=1.0 1.8 1.2, 2.6

parent uses 1.7 1.3, 2.2

Individual-level predictors

Variable OR CI

sex:female=1.0 .42 .26, .68

age 17: 14=1.0 1.8 1.2, 2.6

parent uses 1.7 1.3, 2.2

parent allows 4.8 3.6, 6.3

Individual-level predictors

Variable OR CI

sex:female=1.0 .42 .26, .68

age 17: 14=1.0 1.8 1.2, 2.6

parent uses 1.7 1.3, 2.2

parent allows 4.8 3.6, 6.3

parent concern .58 .45, .74

Individual-level predictors-continued

Variable OR CI

friends tan-20% unit +

1.8 1.6, 1.9

Individual-level predictors-continued

Variable OR CI

friends tan-20% unit +

1.8 1.6, 1.9

value a tan 1.8 1.3, 2.5

Environmental-level predictors

Variable OR CI

Lives within 2 mi of salon

1.4 1.0, 1.9

City salon density was significant in bivariate, but not multivariate, test…

How many facilities?How many facilities?

• average = 41.8 (SD=30.8)• range = 3 (Hialeah,FL) to 183 (New York)• density (per 100,000 people): 1 to 34• average density= 11.8 (SD=6.0)

Hoerster, K. D., et al. (2009). Density of indoor tanning facilities in 116 large U.S. cities. American Journal of Preventive Medicine, 36(3), 243-246.

Average # Businesses per City Average # Businesses per City (n=116)(n=116)

0

10

20

30

40

50

type ofbusiness

Starbucks

McDonalds

Tanning

Hoerster, K. D., et al. (2009). Density of indoor tanning facilities in 116 large U.S. cities. American Journal of Preventive Medicine, 36(3), 243-246.

Living near a tanning salon and Living near a tanning salon and use…use…

• 76% lived within 2 miles of a tanning salon

• For teens having no tanning salons within 2 miles of their home, 7% used indoor tanning in the past 12 months.

• For teens having at least 1 tanning salon, this rate was 11%.

Policy-level predictorsPolicy-level predictors

• Whether state had a youth access law --ns

• Whether salon required parental consent --ns

• Frequency tanning salon would allow teen to tan--ns

Did indoor tanning facilities Did indoor tanning facilities require signed parental consent?require signed parental consent?

• 87% did…

• Requiring consent was significantly related to presence of youth law

• 78% vs. 93%

• OR (no law vs law) = 0.35 (.25, .49)

Pichon, LC, et al. (in press). Youth access to artificial ultraviolet radiation exposure: Practices of 3,647 indoor tanning facilities. Archives of Derm.

Did indoor tanning facilities allow Did indoor tanning facilities allow frequent tanning?frequent tanning?

“I have fair skin…I’m 15 & have never used a tanning bed…How many times can I tan the 1st week?”

• 71% of the salons said every day (mean = 6)

• Frequency allowed to tan not related to presence of a law

Pichon, LC, et al. (in press). Youth access to artificial ultraviolet radiation exposure: Practices of 3,647 indoor tanning facilities. Archives of Derm.

Alaska

Texas

Utah

Montana

California

Arizona

Idaho

Nevada

Oregon

Iowa

ColoradoKansas

Wyoming

New Mexico

Missouri

Minnesota

Nebraska

Oklahoma

South Dakota

Washington

Arkansas

North Dakota

LouisianaHawaii

IllinoisOhio

Florida

GeorgiaAlabama

Wisconsin

Virginia

Indiana

Michigan

Mississippi

Kentucky

Tennessee

Pennsylvania

NorthCarolina

SouthCarolina

WestVirginia

New Jersey

Maine

New York

Vermont

Maryland

New Hampshire

Connecticut

Delaware

MassachusettsRhode Island

28 states (red) had an indoor tanning law

Alaska

Texas

Utah

Montana

California

Arizona

Idaho

Nevada

Oregon

Iowa

ColoradoKansas

Wyoming

New Mexico

Missouri

Minnesota

Nebraska

Oklahoma

South Dakota

Washington

Arkansas

North Dakota

LouisianaHawaii

IllinoisOhio

Florida

GeorgiaAlabama

Wisconsin

Virginia

Indiana

Michigan

Mississippi

Kentucky

Tennessee

Pennsylvania

NorthCarolina

SouthCarolina

WestVirginia

New Jersey

Maine

New York

Vermont

Maryland

New Hampshire

Connecticut

Delaware

MassachusettsRhode Island

21 of those laws (red) included youth access restrictions

Alaska

Texas

Utah

Montana

California

Arizona

Idaho

Nevada

Oregon

Iowa

ColoradoKansas

Wyoming

New Mexico

Missouri

Minnesota

Nebraska

Oklahoma

South Dakota

Washington

Arkansas

North Dakota

LouisianaHawaii

IllinoisOhio

Florida

GeorgiaAlabama

Wisconsin

Virginia

Indiana

Michigan

Mississippi

Kentucky

Tennessee

Pennsylvania

NorthCarolina

SouthCarolina

WestVirginia

New Jersey

Maine

New York

Vermont

Maryland

New Hampshire

Connecticut

Delaware

MassachusettsRhode Island

Case Study: Wisconsin

Banning the Tanning of 15 Year Olds—Confederate Phone Calls

Wisconsin Facilities All Other Facilities

70% 4%

Pichon, LC, et al. (in press). Youth access to artificial ultraviolet radiation exposure: Practices of 3,647 indoor tanning facilities. Archives of Derm.

ConclusionsConclusions

• Parental consent laws are effective, but…

• parents are consenting

Conclusions, continuedConclusions, continued

• Need local zoning ordinances

• “All you can tan” packages-need to restrict these & session frequency • Need teen bans (like France & Australia)

Sec. 4713.50. Under no circumstances shall an operator or employee of a tanning facility allow an individual who is under eighteen years of age to use the tanning services of the facility unless the individual presents a prescription for receivingultraviolet radiation treatments written by a physician authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

Pending Bill in Ohio (HB 230)

Indoor Tanning AssociationIndoor Tanning Association

• Lobbying against pending Ohio law banning those under 18…• Businesses, parents, etc should choose a sample letter and

send to local and state gov’t officials…

“ “Please put some common sense back into government. Whether or not a teen suntans is a decision for parents, not government.”

www.theita.com

Levels of Influence

Policy

Environment

Teens & parents

What will What will CITY100CITY100 do? do?

• Strategically share our data and conclusions with key audiences

• Health organizations, legislators, reporters

What might (should) What might (should) youyou do? do?

• (Continue to) advocate for Ohio’s ban of minors

• Ohio as a model – “As goes Ohio, so goes…”

And thank you!And thank you!

For more information, contact

jmayer@mail.sdsu.edu

Ohio bill information:

www.ohderm.orgGo to section on tanning